"Always do right. This will gratify some people, and astonish the rest." Mark Twain

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Mission Statement (and disclaimer)

* To inform, educate, inspire colleagues and general public by sharing my own experiences, observations, thoughts, and insights drawn from my life and career in medicine and surgery.

* To explore my life and surgical career, as my journey progresses.

* To pose questions, address controversies, frame debate and discussion about/around topics, events, and issues that touch medicine and surgery, and the physicians and surgeons, institutions, and people involved and affected.

This will mainly be framed in the context of personal essays, discussions, conversations, observations (albeit one-sided).

I speak only for myself, the thoughts and opinions are mine; if I quote or borrow from others, appropriate attribution will be made.The educational and other institutions, groups, and organizations I have been and continue to be involved with have not sanctioned or approved the content, my comments here should not and do not reflect their opinions or represent them in any way. Likewise, I do not deign to represent my peers and colleagues. With that said, I hope that I respect and honor them all here in this place.

Posts and the information shared should not be taken as medical or treatment advice; any concerns or problems should be discussed and evaluated with your own physician or health care provider.

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Muted

Smitty greets Sully as they meet to head to work, “Hey there, Sully! How’s your wife?” Sully answers, “Oh, geez. She’s up in bed with laryngitis.” Then Smitty says, “Laryngitis?! That damned Greek!”

First cone of the season, West Boxford, MA

As you may have guessed, I am nursing a case of laryngitis, my voice muted and strained. This time, it has not stopped me from attending to my work responsibilities or other activities. It has required some adjustments though, as I squeak and growl and cough and sputter, my voice robbed of inflection and tone, and even volume control. It is an irony to have to strain my voice to repeat myself because of my strained voice.

I have had more severe laryngitis twice, one time a couple of months ago, another time several years ago. These were so bad, my voice so completely silenced, that I had to change both my operative and office schedules, not just to recover, but because it made my job impossible. We wear masks in the operating room which obscure our expressions and hide our mouths, muffling our voices just a bit; it can be difficult to hear and be heard even with functioning vocal cords. It is impossible if you can’t even manage a whisper.

It is true that learning to (or being forced to) mute your own words and listen more to patients — and colleagues and staff — is not a bad exercise in attention and communication. But in day-to-day practice, there is an expectation of bi-directional conversation, two-way discourse. The doctor is expected to voice opinion, advice, orders. That cannot happen while mute.

In medicine and healthcare we often think about, and talk about, physician-patient communication, but in the abstract. We consider principles and philosophies, we argue the the importance and the need to protect and enhance physician-patient communication. We frame it as a component of the physician-patient relationship, or patient empowerment, or patient-centered care, or patient education, or even informed consent. It will probably be an important piece of the new precision, personalized medicine buzz. Physician-patient communication is the foundation for much in healthcare, whether new hot topics and ideas, or old traditions and approaches.

There are lots of little things we tend to overlook though, in these lofty discussions, that turn out to be no less important when considering the big picture of physician-patient communication, and the big important overarching principles and approaches. Think for a minute about the old saying about trying to sleep with a mosquito in the room, and you will start to understand about small things having great importance, great impact.

These are the small, day-to-day, practical and concrete challenges and barriers to communication, to care. The little things that will tank the most cutting edge and sophisticated solutions and approaches. They could be episodic, like a surgeon with laryngitis, a power failure, downed cell tower or phone line, crashed computer network or server. Or they could be more insidious, lurking continuously in the background, like scheduling protocols that cut time short, technology mismatch when the patient may only have an analog phone, or no phone at all, outdated computer software or no computer at all, no car or transportation, no family. Even language itself may be a barrier rather than a bridge, whether a function of nationality, education, or med-speak jargon.

These little things are potent, despite being small; they are common, nearly ubiquitous. If not accounted for, and certainly if not acknowledged, they may well allow our new solutions to enhance rather than alleviate the disparities and vulnerabilities among those who are most susceptible. We must keep them in mind as we debate our philosophies and principles, as we race towards new technologies and systems.

Disrupting and hacking the systems are popular concepts that are catching our attention and imagination. But if we aren’t careful, the disruption we seek will not be the disruption we get. Remember unintended consequences. Remember that if we aren’t mindful to craft solutions that will include and work for the most challenged and vulnerable among us, the solutions will not likely work well for any of us, and the whole enterprise crashes down, grinds to a halt.

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3 thoughts on “Muted”

Hopesays:

You’re right – and that is just the reason why the ability to think on your feet, to “wing it,” will never lose its value. In music, an orchestra plays together with a score in front of them, and nothing can happen without that structure, without a defined plan. But if the soloist goofs, flubs a few bars, or jumps to the wrong place at a repeat, the experienced, well-trained musicians of the orchestra hear it and immediately adjust. Usually only the trained listener notices: most people don’t even know something irregular happened. So it is with medicine. We follow a script, we know how it’s supposed to go, and then where there’s a glitch, we improvise so it will come out all right. I think Life would be too boring otherwise.